Provider Demographics
NPI:1396843983
Name:MITCHELL, BARRY A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:A
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:743 NORTHFIELD AVE
Mailing Address - Street 2:SUITE #3
Mailing Address - City:WEST ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07052-1107
Mailing Address - Country:US
Mailing Address - Phone:973-736-3042
Mailing Address - Fax:908-889-9370
Practice Address - Street 1:743 NORTHFIELD AVE
Practice Address - Street 2:SUITE #3
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-1107
Practice Address - Country:US
Practice Address - Phone:973-736-3042
Practice Address - Fax:908-889-9370
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI1706103T00000X
NY006708103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1826301Medicaid
NJMI629453Medicare ID - Type Unspecified